21 Jul Cardiac Stents: Life-Long Prevention May Be Needed To Prevent Late Failure
MedicalResearch.com Interview with:
Cheol Whan Lee and
Division of Cardiology, Asan Medical Center,
University of Ulsan
Medical Research: What are the main findings of the study?
Answer: The time window of DES (drug-eluting stent) failure is widely variable from soon after DES implantation to several years after DES implantation. We observed patients with late DES failure are commonly presented with acute coronary syndrome. We hypothesized that temporal patterns of DES failure may be different, and analyzed all patients with first DES failure at our institution. We found that late drug-eluting stent failure is more likely to progress to acute myocardial infarction, aggressive angiographic patterns, and worse outcomes following retreatment.
Medical Research: Were any of the findings unexpected?
Answer: No. As described in #1 answer, the analysis results were compatible with our hypothesis.
Medical Research: What should clinicians and patients take away from your report?
Answer: Early DES failure is now rare with improvement in interventional devices and adjunctive pharmacotherapy. However, as shown in our results, late DES failure is expected to increase due to the widespread acceptance of DES in clinical practice, and the wide time window 1 year after DES implantation. As shown in our results, PCI is not a cure but a control. New diseases can develop within the drug-eluting stent, and may cause late DES failure several years after DES implantation. Therefore, life-long secondary prevention may be needed to prevent late DES failure.
Medical Research: What recommendations do you have for future research as a result of this study?
Answer: Neointimal hyperplasia is the dominant mechanism of early DES failure. Early DES failure within 12 months may be due to local problems with the stent at the affected point. In contrast, late DES failure is more likely related to neoatherosclerosis within the stents. Neoatherosclerotic lesions within stents may progress to tight stenosis and/or plaque rupture, leading to DES failure. Plaque rupture can expose the stent struts, in addition to the lipid core that triggers DES stent thrombosis. Therefore, new therapeutic approach may be needed to prevent late DES failure.
Lee, C. W., Ahn, J.-M., Yoon, S.-H., Lee, J.-Y., Park, D.-W., Kang, S.-J., Lee, S.-W., Kim, Y.-H., Park, S.-W. and Park, S.-J. (2014), Temporal patterns of drug-eluting stent failure and its relationship with clinical outcomes. Cathet. Cardiovasc. Intervent.. doi: 10.1002/ccd.25595